Acute myopericarditis complicating acute tonsillitis: a prospective study.

OBJECTIVES: We describe a prospective study of 100 consecutive cases of acute tonsillitis tested for cardiac involvement. There was 1 clear-cut case of acute myopericarditis and 5 more patients with pathological findings suggesting cardiac complication. METHODS: During a 6-month period (November 2006 to April 2007), we prospectively studied 100 consecutive patients admitted to our department with acute tonsillitis for the purpose of detecting acute myopericarditis. We obtained for each patient a serial electrocardiogram and echocardiogram, and took blood samples. All blood samples were analyzed for the presence of the marker troponin 1 and for cardiac enzymes. RESULTS: One patient (male) had a definitive diagnosis of myopericarditis, and another 5 patients (3 of whom were female) had abnormal cardiac findings suggestive of myopericarditis. CONCLUSIONS: Otolaryngologists should be aware of the possibility of cardiac involvement in acute tonsillitis and perform an adequate workup whenever such a possibility is suspected.

The quality of the surgical field during functional endoscopic sinus surgery--the effect of the mode of ventilation--a randomized, prospective, double-blind study.

OBJECTIVES/HYPOTHESIS: The outcome of functional endoscopic sinus surgery (FESS) depends on a clean surgical field achieved by minimizing intraoperative bleeding. High frequency jet ventilation (HFJV), due to lower airway pressures, offers the benefit of improved venous return, less bleeding, and improved operating conditions. HFJV was compared to intermittent positive pressure ventilation (IPPV) by assessment of surgical conditions and measurement of intraoperative blood loss. STUDY DESIGN: Prospective, randomized, double-blind study. METHODS: A total of 22 patients undergoing FESS were randomly assigned to be ventilated during surgery under general anesthesia by either HFJV or IPPV. The quality of the surgical field was assessed and the total blood loss was measured. RESULTS: The mean airway pressure was significantly lower in the HFJV group than in the IPPV group (2.42 +/- 1.17 and 7.11 +/- 0.72, respectively, P < .0001). The total mean loss of blood in the HFJV group was 170 cc and in the IPPV group was 318.18 cc (P = .017). The quality of the surgical field as estimated by the surgeon was significantly better in the HFJV group. The mean point values on the Boezaart et al. scale for the IPPV and HFJV groups were 2.72 +/- 0.77 and 1.80 +/- 0.686, respectively (P = .012). CONCLUSIONS: HFJV significantly reduced the amount of intraoperative bleeding and thus significantly improved the quality of the surgical field. It is suggested that increased venous return due to lower intrathoracic pressures resulted in less bleeding and improved operating conditions. HFJV can be effectively used for FESS in order to improve endoscopic view with no adverse effects.

Acute myopericarditis complicating acute tonsillitis: beware the young male patient with tonsillitis complaining of chest pain.

OBJECTIVES: We describe 11 cases of myopericarditis complicating bacterial tonsillitis. METHODS: We performed a retrospective study of all cases of myopericarditis treated at one hospital during the years 2005 and 2006. RESULTS: The patients were all young men. The average latency from the onset of throat pain to the onset of chest pain was 4.6 days. All patients complained of chest pain. The most common electrocardiographic finding was transient ST segment elevations. The levels of cardiac enzymes and troponin were elevated in all cases. CONCLUSIONS: Otolaryngologists should be aware of this rare entity. Additional studies are indicated to evaluate the exact incidence of myopericarditis associated with acute streptococcal tonsillitis.

Harmonic scalpel tonsillectomy using the curved shears instrument versus cold dissection tonsillectomy: a retrospective study.

OBJECTIVES: We compared operating time, intraoperative blood loss, and rate of postoperative bleeding in harmonic scalpel (HS) tonsillectomy using the curved shears instrument to those in cold dissection (CD) tonsillectomy. METHODS: The charts of 560 patients who underwent tonsillectomy were retrospectively reviewed. Three hundred nineteen patients underwent CD tonsillectomy between the years 1998 and 1999, and 241 patients underwent HS tonsillectomy using the curved shears instrument between the years 2001 and 2005. For the purpose of evaluation of postoperative bleeding rates, the groups were further stratified by age (11 years of age or less versus 12 years of age or more). RESULTS: For the HS group, the mean operating time was shorter (7 minutes versus 17.57 minutes) and the intraoperative blood loss was lower (0 mL versus 42.12 mL). These differences were statistically significant (p < .05). There was no significant difference in the overall postoperative bleeding rates between the two groups. The postoperative bleeding rate in the HS patients 11 years of age or younger was lower than that in the equivalent age group in the CD group (0.56% versus 2%, respectively), although this difference did not reach statistical significance. The postoperative bleeding rate in the HS patients 12 years of age or older was significantly higher than that in the equivalent age group in the CD group (7.93% versus 1%, respectively; p < .05). CONCLUSIONS: Harmonic scalpel tonsillectomy using the curved shears instrument offers advantages over CD tonsillectomy regarding operating time and intraoperative blood loss. In our patients more than 12 years of age, HS tonsillectomy using the curved shears instrument was associated with an increased postoperative bleeding rate compared to CD tonsillectomy.

Nasal septal perforation repair using oral mucosal flaps.

BACKGROUND: Surgery for the closure of nasal septal perforations is challenging. Numerous techniques have been described. OBJECTIVES: To assess whether nasal septal perforations heal less consistently if a connective tissue scaffold is not placed between the repaired septal flaps. METHODS: We performed closure of a septal perforation via a closed approach using oral mucosal flaps without the interposition of a connective tissue graft in seven patients. RESULTS: Complete perforation closure was achieved in 5 cases (71.4%). There was no significant donor site morbidity. CONCLUSIONS: These initial results suggest that this is an effective technique for closing nasal septal perforations; it obviates the morbidity of the open approach and the added operating time and morbidity associated with the harvesting of a connective tissue graft.

[Post-tonsillectomy hemostasis: a prospective, randomized, double-blind study comparing argon beam coagulation and monopolar electrocoagulation].

BACKGROUND: Argon Beam Coagulation (ABC) enables effective hemostasis and limited penetration depth of the coagulation zone. OBJECTIVE: This prospective, randomized, double-blind study compares ABC and monopolar electrocoagulation for post-tonsillectomy hemostasis. METHODS: Fifty patients undergoing elective tonsillectomy were enrolled into the study. Final hemostasis was achieved using ABC in one fossa and electrocoagulation in the other fossa, with the sides chosen at random. Postoperative bleeding, postoperative pain and the healing of the tonsillar fossa were compared for both methods. RESULTS: No differences in any of the outcome measures were found between the two methods. ABC was felt to be faster and more comfortable than monopolar electrocoagulation. CONCLUSION: ABC is an effective and comfortable method for post-tonsillectomy hemostasis.

Diagnostic evaluation of foreign body aspiration in children: a prospective study.

AIM: The aim of this study was to evaluate the yield of clinical symptoms, signs, and radiological studies in the diagnosis of foreign body aspiration (FBA) in children. METHODS: During the 2-year study, we performed on all children admitted to the pediatric department for suspected FBA a protocol that included the following: thorough medical history, physical examination, radiological studies (chest x-ray and fluoroscopy), and rigid bronchoscopy by a senior otolaryngologist. The yield of these measures for the diagnosis of FBA was evaluated. RESULTS: Foreign bodies were found in 56 (57%) of the 98 children with suspected FBA. Thirty-three (59%) children were boys and 23 (41%) girls (P < .05), with a mean age of 24 months (range, 8-84 months). Main symptoms in the children with FBA were the following: choking (76.8%), prolonged cough (14.3%), dyspnea (3.6%), and nonresolving pneumonia (1.8%). Physical examination, chest x-ray, and fluoroscopy findings were abnormal in 80.4%, 67.9%, and 46.9% of the children with FBA, respectively. The diagnostic yield of physical examination and radiological studies increased 24 hours after the event of FBA. In 45.2% of the children with positive history but with normal findings from physical examination and radiological studies, foreign bodies were found. Of the children with "doubtful" history, physical examination, chest x-ray, and fluoroscopy findings were abnormal in 58%, 38%, and 12.5%, respectively. Foreign bodies were found in 9.5% of these children. CONCLUSION: Medical history is the key for the diagnosis of FBA. Choking followed by an acute episode of coughing is the most common presentation of FBA. The yield of physical examination and radiological studies in the diagnosis of FBA is relatively low but is increased when the presentation is delayed and when history is doubtful. If FBA is suspected, bronchoscopy should be performed.

Mal de debarquement and posture: reduced reliance on vestibular and visual cues.

OBJECTIVE: The neural mismatch theory assumes that the intersensory conflicts leading to motion sickness are resolved by changes in the relative weighting of the various senses that contribute to orientation. If this sensory rearrangement persists after disembarkment, it might result in mal de debarquement (MD): ataxia and a rocking sensation sometimes felt after landing. The objective of the present study was to examine possible changes in sensory organization in naval crew members with differing susceptibility to MD with computerized dynamic posturography (CDP). STUDY DESIGN: Cross-sectional parallel-group design. METHODS: Seventeen subjects susceptible to MD (SMD) and 17 subjects nonsusceptible to MD (NSMD) (healthy male volunteers aged 18-22) participated in the study. CDP was performed twice with each subject, before and immediately after sailing, using the EquiTest system (NeuroCom, Inc., Clackamas, OR). RESULTS: The SMD group showed a significant reduction in their scores on sensory organization tests 3, 4, and 5 after sailing. Sensory pattern analysis revealed reduced use of inputs from the vestibular and visual systems to maintain balance. Prolonged latencies of the motor responses to unexpected pitch perturbations were also recorded in the postsailing CDP of the SMD group. Reduced performance on the presailing CDP task, which presents the greatest challenge to the vestibular system, was found to control for the presence of MD postsailing. CONCLUSIONS: The results show that MD is associated with postural instability, slower motor reflexes, and larger sways in response to abrupt changes in the body's center of gravity. These findings may be explained by under reliance on vestibular and visual inputs and increased dependence on the somatosensory system for the maintenance of balance.

Acute edema of the tongue: a life-threatening condition.

Acute macroglossia is rare, but may cause upper airway obstruction requiring emergency intervention. The cause of the problem is often obscure. Edema of the tongue may be due to angioedema or to allergy. We present several cases of acute edema of the tongue, in 3 cases causing life-threatening airway obstruction. Among these, we present the first case of acute enlargement of the tongue due to the ingestion of artichoke.

[Malignant teratocarcinosarcoma of the nose and paranasal sinuses].

Malignant teratocarcinosarcoma of the nasal cavity and the paranasal sinuses is a rare and invasive tumor. It is characterized by a mixture of mesenchymal and epithelial components, with cellular elements of a fetal nature. We describe in detail the first and only case in Israel of a patient with such a tumor. Only 40-50 such cases have been described in the medical literature. We have also reviewed the existing literature dealing with malignant teratocarcinosarcoma.